Healthcare Provider Details

I. General information

NPI: 1356964340
Provider Name (Legal Business Name): JAMES WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2020
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 E DEL MAR BLVD
PASADENA CA
91107-4375
US

IV. Provider business mailing address

1214 W 51ST ST
LOS ANGELES CA
90037-3419
US

V. Phone/Fax

Practice location:
  • Phone: 626-356-2556
  • Fax:
Mailing address:
  • Phone: 213-321-0569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95027871
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95065720
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: